When the System Around the Doctor Gets in the Way of Care
For years, we’ve talked about the problems in American healthcare as problems of cost.
Healthcare costs continue to rise, with employers paying more every year and employees shouldering more of the cost out of pocket. Yet despite how much they spend, getting timely, high-quality care often feels harder than it should.
It's time we look at what has happened to the way care itself is organized, and what that means for the physicians delivering it.
New research from the Physicians Advocacy Institute paints a striking picture.
Today, 82% of physicians are employed by hospitals, health systems or other corporate entities.
Among employed physicians surveyed:
- 63% report barriers to referring patients outside their network
- 59% feel pressure to keep patients within their health system
- 47% frequently feel pressure to prioritize patient volume over optimal care
- 73% say their patients cannot get timely care
Those statistics should concern anyone responsible for the health of a population. Because what physicians are being asked to navigate doesn’t stay behind the scenes. Patients experience the consequences every day.
Patients feel it in rushed appointments, long wait times, and the disconnect between the doctor who’s supposed to know them best and the specialists treating individual pieces of their health.
Physicians feel it in days packed with back-to-back appointments, too little time with each patient, and hours spent on documentation, referrals, prior authorizations, and pharmacy calls. They feel it in knowing a patient needs more time than they can give them, and in having less freedom to make the decisions they believe are best for their care. This moral injury is heartbreaking.
Primary care has become harder to practice as intended.
At its best, primary care should be the place where someone knows you and your health history. It should be where problems are caught early, where someone helps you understand what to do next, and where you have a trusted advocate when you need more complex care.
But the way healthcare is organized today can make that increasingly difficult. When physicians have too little time with patients and limited flexibility in where they can direct their care, it gets hard for primary care to do its job.
The consequences extend beyond a frustrating experience.
When primary care can’t play that role, problems can go unmanaged longer, patients can end up in more expensive settings, tests can be duplicated, and referrals can be shaped by where a physician practices rather than where a patient can get the most appropriate care.
If we want better clinical outcomes and lower costs, we need a fundamentally different approach to primary care.
That starts with creating an environment where physicians have the time to know their patients, the autonomy to make the right clinical decisions, and the ability to guide patients to the right care based on what is best for them.
Primary care can’t fulfill its role when physicians are stretched across thousands of patients and care is fragmented across disconnected providers.
It needs to be the place where someone sees the whole picture, intervenes earlier, and stays accountable for what happens next.
This is why we believe primary care that operates independently from hospital systems and is paid to keep people healthy has such an important role to play, giving physicians greater autonomy over how they care for patients and where they refer them.
Primary care shouldn’t simply be the front door to more healthcare. Physicians need the time and resources to manage more of a patient’s care themselves, intervene earlier, and when specialty care is needed, guide patients to the right place and remain connected to what happens next.
For patients, that means more personal care from someone who knows them, understands the full picture of their health, and helps connect the pieces of their care. For employers, it means fewer unnecessary services, better use of specialty care, and ultimately, a different trajectory for healthcare spending.
Better healthcare starts with a better relationship
We spend a lot of time debating how to make healthcare less expensive, but perhaps the more fundamental question may be whether the way healthcare is organized today makes it easier or harder for doctors to take care of people.
Because better primary care starts with something remarkably simple: a doctor who has the time to know their patient, manage more of their care, and stay accountable for what happens next. If we can restore that relationship, better outcomes and lower costs can follow.
Originally published on LinkedIn